Caries prevalence, gingivitis and attitudes towards oral health among 50–60-year-old Germans

Caries prevalence, gingivitis

and attitudes towards oral health among 50–60-year-old Germans

Corresponding author:

Dr. Petra Hahn, Albert Ludwigs University Freiburg, Dental Clinic, Department of Operative Dentistry and Periodontology, Hugstetterstrasse 55, 79106 Freiburg, Germany

Tel: +49/ 761/270-4756, Fax: +49/761/ 270-4762, E-mail: hahn@zmk2. ukl.uni-freiburg.de

Summary

The objective of the present study is to evaluate the oral health of German adults between 50 and 60 years of age, and to determine to what extent it is associated with person- al factors of gender, general health, nutritional attitudes, dental attendance, education, and oral hygiene.

Two dentists examined 298 subjects (40% male, 60% female) in a city in southwest Germany according to the following parameters: Papillary Bleeding Index (PBI), Quigley Hein Plaque-Index (PI), probing pocket depth and DMF/T. Inter- views were conducted to gather information relevant to the personal factors.

The mean number of functional teeth per subject was 22.8 (4.13). The mean DMF/T-index was 18.7 (4.85). The mean PI was 1.57 (0.49). The mean PBI was 0.84 (0.60) and the mean probing pocket depth was 2.8 mm (0.68).

A significant correlation between DMF/T scores and probing pocket depth, but not between frequency of tooth brushing and probing pocket depth was observed. Frequency of tooth brushing showed no correlation with DMF/T values. A significant correlation was observed between DMF/T scores and gender, nutritional attitudes and dental attendance, and between DT scores and cigarette smoking, while no correla- tion was shown between the personal factors general health and education, caries prevalence and gingival health.

In conclusion, few subjects between 50 and 60 years of age have problems with caries. However, the skewed distribution of D-teeth points out the need to refocus dental services on more individual, prophylactic therapy.

Acta Med Dent Helv 4: 167–172 (1999)

Key words: Adults, caries prevalence, associated factors Accepted for publication: 2 August 1999

Introduction

Despite the fact that their etiology is largely understood, caries and gingivitis remain widespread in the adult populations of in- dustrialized countries (BADER et al. 1993, CLARKSON & WOR-

THINGTON 1993, B^UDTZ-J^ØRGENSEN et al. 1996, E^RIKSEN et al.

1996). While we know today that caries and many cases of peri- odontitis are avoidable (H^OLSTet al. 1997), it seems that many adults in Germany still suffer from caries and periodontal prob- lems (M^ICHEELIS& B^AUCH1996). While this is likely owing to in- adequate preventive practices in the past (HUGOSONet al. 1995), a second contributing factor may be the extension for prevention restorative approach to dental treatment still commonly prac- ticed by dentists (B^ADERet al. 1993). A better understanding of the biological processes behind caries initiation and progression as well as growing acceptance of the concept of remineraliza- tion of dental hard tissue may lead to a more conservational and preventive approach in the future.

Data pertaining to caries prevalence and gingivitis in middle- aged adults in Germany are scarce. In 1997, we began a prospective, longitudinal study of the effect of certain preventive measures on oral health in a group of 50–60-year-old subjects in Germany. We assessed caries prevalence, gingival health and various personal factors. The objective of the study was to detect possible associations between dental and gingival parameters and personal factors of gender, general health, nutritional atti- tudes, dental attendance, education, and oral hygiene.

Materials and Methods

Study participants were recruited in a city of 200,393 inhabitants in southwestern Germany. According to the study design, only subjects between 50 and 60 years old with a minimum of 10 teeth were eligible.

A market-research institute recruited volunteers by placing an advertisement in a local newspaper for a period of four weeks.

Interested persons were encouraged to contact the research institute by phone. After telephone conversations of about

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1 Albert-Ludwigs-University, Department of Operative Dentistry and Periodontology, University of Freiburg, Germany, and

2 Department of Oral and Maxillofacial Surgery, Dental Clinic, University of Cologne, Germany

15 minutes in which the details of the study were discussed, 90% of the callers agreed to participate.These (n = 300) were in- vited to come for the baseline investigation, and all participated after signing an informed-consent form.

The investigation consisted of two parts: an interview and a clinical examination. The clinical and sociological methods and instruments used in the study were originally established for two cross-sectional surveys in 1989 and 1992 (MICHEELIS &

B^AUCH1996) and are described in a separate publication (E^IN-

WAGet al. 1992). The sociological survey section was developed at the Institute of German Dentists using relevant literature from the field of empirical, social and health research in Ger- many (S^CHEUCH1973, S^IEGRIST1988). With the help of the mar- ket-research institute, the questionnaire was adapted to meet the requirements of the present study. The diagnostic criteria and the data-recording manual (EINWAGet al. 1992) used in the study accord with WHO criteria for the diagnosis of dental caries (MICHEELIS& BAUCH1996).

Both parts of the investigation took place at the Department of Operative Dentistry of the Dental Clinic at the University of Freiburg. Professional interviewers questioned the subjects in order to ascertain: socio-demographic and socio-economic background; subjective perception of dental health; frequency of dental attendance; previous periodontal treatment; existing preventive health habits; attitudes towards proper nutrition; at- titudes towards sugar consumption; and attitudes towards den- tal treatment. Participants were also questioned about their medical histories and subsequently examined by the two inves- tigating dentists. Depending upon the results, they were then divided into two groups, one containing those with severe prob- lems undermining their general health and another containing those whose histories were uneventful.

The clinical examinations were carried out by two experienced dentists at a rate of 15–20 subjects per day over a period of about three weeks. In order to better ensure the reproducibility of re- sults, the two dentists jointly examined patients prior to the start of the study until assessment correspondence with regard to the study parameters was achieved.

The full mouth recording included the following parameters:

restorations (fillings and crowns), gingival health, oral hygiene and caries prevalence. The number of missing teeth was also recorded. Third molars were not included in the examination.

In order to assess gingival health, the Papillary Bleeding Index (PBI, MÜHLEMANN1978) was used. The probing pocket depth of each tooth was evaluated mesially and distally. The gingival ex- amination was performed with a periodontal probe with a 1 mm scale. Oral hygiene was evaluated using the Turesky modifica-

tion of the Quigley and Hein Plaque-Index (PI, T^URESKYet al.

1970). Calculus was not removed prior to the examination.

Caries diagnosis was carried out carefully by visual and tactile examination, using a standard operating light, a plane mouth mirror and a blunt dental probe. In contrast to WHO (1987) cri- teria, no CPI probe was used. The teeth were dried with an air syringe before inspection. Diagnostic criteria distinguished be- tween primary and secondary caries, as well as between missing teeth and restored and sound teeth and surfaces. In keeping with WHO criteria, active caries was recorded as present when the respective lesion on the crown or root surface showed an unmistakable cavity, undermined enamel, or a detectably soft- ened area. The probe was used to confirm visual evidence of caries. Areas with only visual evidence of demineralization, i.e., only brown or chalky staining, but no soft surface, were deemed sound. A restored crown or root surface with caries at its margin was classified as recurrent decay (F^URE& Z^ICKERT1990). This distinction between primary and secondary caries does not con- form to WHO criteria. No x-rays were taken.

For purposes of statistical analysis, educational level was divid- ed in three categories: low (elementary school), medium (high- school with or without degree), and high (college or university).

Subjects’ attitudes towards different parameters were initially judged as very important, important, less important and unim- portant, and later, for purposes of analysis, as important and unimportant.

Results were presented as mean values (± standard deviation).

The Pearson-correlation coefficient was used to establish corre- lations among the clinical parameters PI, PBI, probing depth and DMF/T. The t-test was used to determine the relationship between the clinical parameters and the information gathered during the personal interviews. All statistical tests were carried out at 0.05 level of significance.

Additionally, the analysis was performed by alternately model- ing DMF/T, DT, MT, FT, PI, PBI and probing pocket depth through multiple regression. Predictor variables included gen- der, education, attitude towards low-sugar nutrition, fluoride measures, dental attendance and smoking.

Results

The study population consisted of 300 subjects. In two cases, the questionnaires were not filled in correctly. The remaining 298 participants consisted of 179 females (60%) and 119 males (40%) between the ages of 50 and 60. The age distribution within the population was uniform, with an average age of 54.7 (female 54.6, male 54.9).

Table I Caries indices, PI, PBI and probing pocket depth by gender: Median, and mean values, standard deviation (sd), and statistical differences.

total male female t-test

(n = 298) (n = 119) (n = 179) p-value

median mean ±sd median mean ±sd median mean ±sd

Number of teeth 25 22.82 4.13 25 23.24 3.86 25 22.52 4.30 –

DMF/T 19 18.7 4.85 19 18.11 5.08 19 19.10 4.67 0.090

D 1 1.35 2.02 1 1.49 2.20 1 1.26 1.89 0.350

MT 3 4.31 4.11 3 4.15 3.94 3 4.33 4.22 0.939

FT 13 13.05 4.44 13 12.47 4.41 14 13.43 4.43 0.629

PI 1.51 1.57 0.49 1.62 1.63 0.50 1.50 1.51 0.48 0.036

PBI 0.75 0.84 0.60 0.77 0.85 0.61 0.71 0.83 0.59 0.799

Probing depth 2.80 2.80 0.68 2.84 2.85 0.73 2.78 2.77 0.66 0.311

Dental Status

A mean of 22.82 (± 4.13) teeth was preserved, with 15% of the subjects having all and 82% having more than 20 teeth in func- tion. The mean DMF/T score was 18.7 (± 4.85). DMF teeth were distributed as follows: 1.35 DT (± 2.02), 4.31 MT (± 4.11) and 13.05 FT (± 4.44). T-test results revealed no difference between male and female DMF/T scores (Table I). Smokers’ teeth (1.92 ± 2.75) showed significantly more decay than those of non-smok- ers (1.19 ± 1.74, p = 0.047, Table II). Eighty-five percent of the participants exhibited no primary caries (mean: 0.21 ± 0.67) and 80% exhibited no secondary caries (mean: 0.32 ± 0.78) in the coronal part of the teeth.

The DMF/T frequency distribution (Table III) across the whole study population was only slightly skewed. Fifty percent of the subjects made up for 59.2% of the DMF teeth. FT results were slightly more skewed, with 50% of the subjects making up for 63% of the F teeth. The mean FT score was 13.05 (± 4.44). With a mean of 7.49 (± 4.44), more than half of all restored teeth had been restored with crowns – more frequently in the case of fe- males (7.85 ± 4.47) than males (6.99 ± 4.74). Only 8% of all sub- jects had no crowns and only 3% no fillings. Skewed distribu- tion was considerably pronounced with respect to MT and DT.

Fifty percent of the subjects made up for 84.4% of the missing teeth and 96.5% of the decayed teeth. Nearly half (45.3%) of the D teeth were found in 10% of the population.

Oral Hygiene and Gingival Health

Analysis of subject responses to questions concerning personal oral hygiene showed that females claimed to brush their teeth more often than males (t-test: p ≤0.001). The mean PI (1.57 ± 0.49) showed significantly higher scores for males (1.63 ± 0.50) than for females (1.50 ± 0.48, p < 0.05, Table I). All subjects claimed to brush their teeth at least once a day. While only 13.8% of the population had received professionally-applied topical fluoridation, this had no influence on DMF/T scores.

Seventy percent of the subjects had an average probing pocket depth of ≤3 mm, and only 1% an average depth of ≥6 mm. PBI

(p < 0.05, correlation coefficient R = 0.11914), PI (p < 0.01, cor- relation coefficient R = –0.17930), and probing pocket depth (p < 0.01, correlation coefficient R = 0.1375) revealed low corre- lation coefficients with DMF/T. Frequency of tooth brushing showed no significant influence on DMF/T.

Smokers comprised 21% of the study population. Probing pock- et depth and PBI were significantly correlated with smoking, while PI revealed no correlation. Smokers showed a mean prob- ing pocket depth of 3.1 mm (± 0.78) and a PBI of 0.69 (± 0.52).

Non-smokers showed a lower mean probing pocket depth of 2.7 mm (± 0.65), but a higher mean PBI of 0.88 (± 0.61, Table II).

Fewer males (25%) had received periodontal treatment than fe- males (36%). In general, those participants who had received periodontal treatment had significantly more missing teeth (5.03 ± 4.30) than those who had received no treatment (3.97 ± 3.98, p = 0.044).

Interview

Thirty-five percent of the subjects had reached a low level of education, 42% a medium level and 23% a high level. Level of education was significantly higher for males than for females (p = 0.0004), but as a factor showed no influence on DMF/T scores.

Seventy-eight percent of the subjects had uneventful medical histories (i.e. with at most slight illness). The remaining 22%

had more severe illnesses, e.g. epilepsy (1%), diabetes (2%), ab- normal blood-clotting (3%) and asthma (7%). General health status did not correlate with the dental health parameters.

When interviewed, 99% of the subjects responded that proper nutrition is important for their health, while only 75% said the same of a low-sugar diet. This group had significantly higher DMF/T scores (t-test: p = 0.047).

Fifty-six percent of the subjects had paid their most recent visit to the dentist for a regular examination, and 23% to have their teeth cleaned.These participants showed significantly less tooth decay (DT 1.08 ± 1.53) than the remaining participants, who visited their dentists only when experiencing dental problems (DT 1.82 ± 2.61; p = 0.008). The same tendency was observed for missing teeth (MT 3.9 ± 3.76 and 4.9 ± 4.62, resp.) and DMF/T (18.3 ± 5.02 and 19.4 ± 4.51, resp.), but the differences were not significant (p = 0.052 and p = 0.057, resp.).

A multiple regression analysis was performed for DMF/T, DT, FT, MT, PI, PBI and probing pocket depth with an eye to determin- ing the influence of the variables included in the model, i.e. gen- der, educational level, low-sugar diet, fluoride measures, dental attendance and smoking. With respect to DMF/T (Table IV), the results indicated that (1) DMF/T scores were significantly higher (by an average of 1.27 DMF/T) among female adults; (2) preva- lence of DMF/T was significantly higher among those subjects who visit their dentists only when experiencing problems than those who visit their dentists regularly for annual check ups and teeth cleaning; (3) DMF/T scores (4.74) were significantly higher for participants of the opinion that regular dental attendance is important; (4) the opinion that low-sugar nutrition is not impor- tant for dental health did have a bearing on DMF/T scores; and (5) smoking, education and supplementary fluoride measures had no significant bearing on DMF/T scores.

The results of the regression analysis for the parameters DT and MT were consistent with those for DMF/T in regard to the rea- son for most recent dental attendance (p = 0.0038, regression coefficient b = 0.70 and p = 0.0357, b = 1.05). Additionally, this analysis revealed significant confounding in the case of smoking (p = 0.0325), indicating higher DT scores (regression coefficient Table II DT, PBI, PI and probing pocket depth by smoking

habits:

Mean values, standard deviation (sd), and statistical differen- ces (t-test).

DT PBI PI Probing

depth Smoking yes (n=64) 1.92 0.69 1.61 3.1

habits ± sd ± 2.75 ± 0.52 ± 0.54 ± 0.78 no (n=234) 1.19 0.88 1.53 2.7

± sd ± 1.74 ± 0.61 ± 0.48 ± 0.65

p-values 0.047 0.018 0.282 0.001

Table III Frequency distribution of DMF/T, DT, MT and FT among the participants: Fraction of subjects (%) comprising fraction of DMF/T, DT, MT and FT (%).

Fraction Fraction of subjects of D/M/F teeth

DMF/T 50% 59.2%

DT 50% 96.5%

MT 50% 84.4%

FT 50% 63%

b = 0.62) for smokers than for non-smokers. As for the parame- ter FT, the results showed significantly higher values for females than for males (p = 0.045, regression coefficient b = 1.09). The remaining variables revealed no association with the parame- ters DT, MT and FT.

With regard to gingival parameters, multiple regression analysis revealed a non-significantly lower PI for female subjects than for male subjects (regression coefficient –0.12, p = 0.055). The analysis revealed significantly higher PBI scores for non-smok- ers and a significantly greater probing pocket depth for smok- ers. Probing pocket depth was negatively associated with the opinion that dental attendance is important. There was no sig- nificant mutual confounding between PI, PBI and probing pocket depth and the remaining variables.

Discussion

Owing to particular aspects of the sampling method used, the population examined in the present study was not representa- tive. It is likely that the data present an overly favorable picture of dental health (KALSBEEKet al. 1998).

When comparing prevalence data, it should be appreciated that diagnostic criteria may vary substantially. Furthermore, the fact that there are no existing caries-prevalence data from random samples of 50–60-year-old Germans prevents a critical compar- ison with the data obtained in this study.

Unpublished data cited by CLARKSON & WORTHINGTON(1993) suggest that only 4% of adults over 25 years who visit their den- tists regularly have fewer than 12 teeth. Similarly, FELDMANNet al. (1993) encountered no toothless persons below the age of 54.

Therefore, the inclusion criterion limiting our study population to subjects having at least 10 teeth should have little bearing on the associations found between the clinical parameters and the remaining data evaluated.

The average number of remaining teeth in this study (22.82) is consistent with results of surveys conducted by K^ALSBEEKet al.

(1998), PAPASet al. (1992) and FURE(1998) who found, respec- tively, 22.4 and 21.0 preserved teeth in the same age group and 22.0 in a group of 60-year-olds.

The mean DMF/T score in our results (18.7) is consistent with data taken from other studies showing DMF/T scores between 18.2 and 25.5 (B^ORUTTAet al. 1991, F^ELDMANNet al. 1993, D^UFOO et al. 1996, PISTORIUSet al. 1997, KALSBEEKet al. 1998).

While the present data show no gender-specific differences with regard to DMF/T when assessed by t-test, they show sig- nificantly higher DMF/T scores for women than for men when assessed by multiple regression analysis and controlling for mu- tual confounding among the variables gender, educational lev-

el, low-sugar nutrition, fluoride measures, dental attendance and smoking. While BUDTZ-JØRGENSENet al. (1996) and FELD-

MANNet al. (1993) found no relationship between caries preva- lence and gender, other studies revealed significantly higher DMF/T scores for females than for males (B^JERTNESS& E^RIKSEN 1992, ERIKSENet al. 1996, PISTORIUSet al. 1997). Furthermore, the FT scores are significantly higher for females than for males in the present study, but the DT and MT scores show no significant gender-specific differences. Thus, this does not mean that fe- males have more unrestored caries and missing teeth, but more restorations – particularly, more crowns – than males. This sug- gests that the overall DMF/T scores are more likely an indicator of attitudes towards restorative care than of caries prevalence.

In contrast to the results of the present study, BJERTNESS& ERIK-

SEN(1992) and A^LVAREZ-A^RENALet al. (1996) found higher val- ues for carious teeth in 50-year-old Norwegians (3.0 DT) and in 45–64-year-old Spaniards (2.4 DT). German epidemiological data from 1989 (BORUTTAet al. 1991) found 1.7 DT in a group of 45-54-year-olds.

The incidence of carious teeth in the study population reveals a skewed distribution vis-a-vis the number of MT and DT. Our data pertaining to M and D scores confirm the results of a study conducted by Vehkalahti (V^EHKALAHTI: J Dent Res 77 [Abstract 657] 714, 1998) in 30–65-year-old subjects in Finland.

P^ISTORIUS et al. (1997) found 5.9 missing teeth in a group of 46–64-year-olds in Germany, while ALVAREZ-ARENAL et al.

(1996) reported an MT score of 8.0 for Spain. F^ELDMANNet al.

(1993) found 13.6 missing teeth in a group of 55–64-year-olds in Switzerland. The comparably low MT scores in the present study (4.3) can be attributed, at least in part, to the inclusion cri- terion requiring that subjects have at least 10 remaining teeth.

The mean FT score of 13.5 is relatively high. While FELDMANNet al. (1993) found a similarly high FT score of 12.1 among 45–64- year-olds in Switzerland, ALVAREZ-ARENALet al. (1996) reported approximately 2.1 filled teeth among 45–64-year-olds in Spain.

In their study, the FT score was extremely low (16.8% of DMF/T) compared to the MT score (64% of DMF/T). They described an urgent need for treatment, especially for pontics (5.6). In con- trast, the MT score in our study group is 23.1% of the whole DMFT and the FT score is 69.8%. About half of these had been restored with crowns – a figure consistent with results obtained by FURE& ZICKERT(1990) who found crowns responsible for 47% of all filled surfaces in Sweden. These high filling and crown scores are likely also reflective of the kind of dental ser- vices available in Germany.

It is well known that regions whose populations exhibit low rates of restorative dental care received have a correspondingly low number of dentists (DUFOOet al. 1996, ALVAREZ-ARENALet al. 1996). Inversely, one may find a potential source for the rela- tively high FT scores in our results in a “dentist treatment ef- fect”. DF/T is not a linear measure of caries incidence for the simple reason that some tooth surfaces may have been filled that were not truly carious. Indeed, this factor may substantially influence study results (BADER et al. 1993) This treatment-ef- fect hypothesis gains support from a conspicuous result ob- tained in the present study: multiple regression analysis re- vealed 4.74 higher DMF/T in subjects of the opinion that regular dental attendance is important.

On the basis of their responses, female subjects in this study brush their teeth more often than the males, and their PI scores are, correspondingly, significantly lower. P^AYNE& L^OCKER(1996) found that females, the elderly and those with higher incomes are more likely to maintain better health habits. But there is no Table IV Multiple regression analysis for the association of

DMF/T with a series of studied variables.

DMF/T

Variables b p

Gender male/female 1.2748 0.0296

Education low/middle/high 0.1587 0.6749 Low-sugar nutrition important/unimportant 1.3424 0.0412

Fluoride measures yes/no 1.2076 0.1381

Dental attendance important/unimportant –4.7400 0.0068 Reason for last visit control/problems 1.3381 0.0202

Smoking habit yes/no –0.4795 0.4878

b = regression coefficient

general consensus on the effects of oral hygiene on oral health in the literature. Significant correlations have been demonstrat- ed between number of carious surfaces and oral hygiene index (BUDTZ-JØRGENSENet al. 1996) and between DMF/T and plaque index (P^ISTORIUSet al. 1997). Our investigation, however, reveals only a very slight correlation between PI and DMF/T, which should not be overemphasized. Frequency of brushing also shows no significant influence on DMF/T and probing pocket depth. In keeping with our results, most studies have failed to demonstrate a relationship between caries and personal oral hygiene (B^ELLINIet al. 1981, B^JERTNESS& E^RIKSEN1992, E^RIKSEN et al. 1996). This may, however, highlight the importance of a proper technique for plaque removal, and, at the same time, point out the importance of motivation and instruction of the proper technique.

In our study, PBI and probing pocket depth are slightly correlat- ed with DMF/T. Similar results were found by P^ISTORIUSet al.

(1997) for gingival index. There may be additional factors apart from oral hygiene (e.g. cigarette smoking) that contribute to caries and periodontal destruction. Indeed, our study indicates that these two dental-health parameters are significantly influ- enced by smoking. Smoking has been identified as a risk factor for moderate and severe periodontitis (P^AGE& B^ECK1997). In our investigation, smokers exhibit greater probing pocket depth and lower PBI, but no difference in plaque index. A possible ex- planation for the surprisingly low PBI scores for smokers in our investigation could be the local effects of smoking, such as re- duction in gingival blood flow due to the vasoconstricting ac- tions of nicotine (B^ERGSTROM & F^LODERUS 1983, P^REBER &

BERGSTROM1985, GOULTSCHINet al. 1990).

In keeping with the observations of E^RIKSENet al. (1996), the general health of the subjects in our study is not correlated with caries. But it must be taken into account that people with severe health problems tend not to volunteer for such studies.

The subjects whose opinion it is that low-sugar diet is not very important, have significantly higher DMF/T scores than those who place great emphasis on a low-sugar diet. SAKKI et al.

(1994) also found an association between dietary habits and caries.

The correlation between cigarette smoking and caries prevalence found in our study corroborates data obtained by B^JERTNESS&

ERIKSEN(1992), SAKKIet al. (1994) and DRAKEet al. (1997).

The existing data concerning dental health and smoking point out the important role dentists could play in making patients aware of smoking’s detrimental effects both on dental and peri- odontal tissue and on health in general.

Nearly 80% of the participants visit their dentists regularly (ei- ther for standard check ups or professional cleaning) and exhib- it correspondingly less tooth decay. The same correlation was found by ERIKSENet al. (1996). However, while the opinion that regular dental attendance is important is significantly correlated with higher DMF/T scores, it is not correlated with DT scores.

This is again an argument suggesting that DMF/T scores are not a suitable indicator of caries prevalence, particularly in popula- tions where restorative options are highly available.

Although the prevalence data recorded are not representative, they are consistent with results found in representative studies of other age groups. Therefore, the associations identified in representative studies could be expected to apply to German adults of the age group studied here (PETRIDOUet al. 1996).

The data presented in this investigation testify to a dental com- munity well-equipped for restorative treatment and a popula- tion committed to regular dentist-office attendance. These fac-

tors are responsible for the following overall outcome: in Ger- many, few carious lesions are left unrestored.

Several parameters (i.e. gender, nutrition, dental attendance) are associated with DMF/T scores. The significant correlation between the smoking and DT scores and between stated reason for dental attendance and DT scores provide even more specific information about persons with higher caries risk.

These associations, together with skewed distribution of D- teeth, should be seen as a reason to promote individualized pre- ventive measures, for instance, involving proper nutrition, cor- rect oral hygiene, additional fluoridation, and more frequent professional tooth cleaning. In this way, the incidence of new caries lesions can be reduced and the life of existing restorations prolonged.

Acknowledgement

The authors would like to thank Wybert GmbH (Lörrach, Ger- many) for financial support.

Zusammenfassung

Ziel der vorliegenden Studie war es, den oralen Gesundheitszu- stand bei einer Gruppe 50–60-jähriger Deutscher zu unter- suchen. Es sollte zudem der Zusammenhang zwischen Mundgesundheit und Geschlecht der Probanden, allgemeiner Gesundheit, Ernährung, Häufigkeit des Zahnarztbesuches, Bil- dungsstand und Mundhygienegewohnheiten evaluiert werden.

Zwei Zahnärztinnen erfassten bei 298 Personen (40%

männlich, 60% weiblich) aus einer Stadt im Südwesten Deutschlands folgende Parameter: Papillenblutungsindex (PBI), Quigley Hein Plaque Index (PI), Sondierungstiefen und DMF/T.

Die übrigen Informationen wurden während eines Interviews gesammelt.

Im Durchschnitt waren noch 22,8 Zähne vorhanden. Der DMF/T-Index betrug 18,7 (± 4,85), der PI 1,57 (± 0,49), der PBI 0,84 (± 0,60) und die mittlere Sondierungstiefe 2,8 mm (± 0,68).

Es konnte eine signifikante Korrelation zwischen DMF/T und Sondierungstiefe nachgewiesen werden. Zwischen Zahn- putzhäufigkeit der Teilnehmer und dem DMF/T und der Sondierungstiefe wurde keine Korrelation festgestellt. Die Kariesprävalenz korrelierte signifikant mit dem Geschlecht, den Rauchgewohnheiten, der Ernährung und der Häufigkeit des Zahnarztbesuches. Der allgemeine Gesundheitszustand und das Bildungsniveau beeinflussten den DMF/T-Wert und die Gesundheit der Gingiva nicht.

Zusammenfassend lässt sich feststellen, dass 50–60-jährige wenig kariöse Läsionen haben. Die deutliche Polarisation bei der Verteilung der kariösen Zähne dieser Population verdeut- licht, dass eine zielgerichtete Individualprophylaxe notwendig ist.

Résumé

Des examens dentaires et buccaux ont été effectués sur 298 per- sonnes (age 50–60 ans) dans notre service. L’indice DMF-T, l’in- dice d’hygiène (Quigley Hein, PI), l’indice d’inflammation de la gencive (PBI) et les valeurs au sondage (PPD) ont été retenus.

Les autres informations ont été obtenues au moyen d’un ques- tionnaire.

La moyenne de l’indice DMF-T était de 18,7 (± 4,85), celle de l’indice PI était de 1,57 (± 0,49), celle de PBI était de 0,84 (± 0,60) et celle du sondage était 2,8 mm (± 0,68).

Une relation directe entre l’indice DMF-T et les valeurs au son- dage a pu être démontrée. Mais il n’y avait pas de relation signi- ficative entre l’hygiène dentaire et l’indice DMF-T ou les valeurs au sondage. La prévalence de la carie était en corrélation avec le sexe, la consommation de tabac, l’alimentation et la fréquence des consultations du dentiste.

Les personnes faisant partie de ce groupe montraient une pola- risation évidente de la distribution de la carie. Ceci démontre que le but des efforts de prophylaxie de la carie n’est pas encore atteint à cet âge. En conséquence, une prophylaxie plus indivi- duelle et efficace est nécessaire non seulement pour les jeunes, mais aussi pour les personnes d’âge moyen.

Literature

ALVAREZ-ARENALA, ALVAREZ-RIESGOJ A, PENALOPEZJ M, FER-

NANDEZV^AZQUEZJ P, V^ILLAV^IGILM A: DMFT and treatment needs in adult population of Oviedo, Spain. Community Dent Oral Epidemiol 24: 17–20 (1996)

BADERJ D, SHUGARSD A, ROZIERR G: Relationship between epi- demiological coronal caries assessment and practitioners’

treatment recommendations in adults. Community Dent Oral Epidemiol 21: 96–101 (1993)

BELLINIH T, ARNEBERGP,VON DERFEHRF R: Oral hygiene and caries. A review. Acta Odontol Scand 39: 257–265 (1981) BERGSTRØMJ, FLODERUS-MYRHEDB: Co-twin study of relation-

ship between smoking and some periodontal disease factors.

Community Dent Oral Epidemiol 11: 113–116 (1983) B^JERTNESS E, E^RIKSEN H M: Design of a socio-ecologic caries

model and testing on 50-year-old citizens of Oslo, Norway.

Acta Odontol Scand 50: 151–162 (1992)

BORUTTAA, KÜNZELW, MICHEELISW, MÜLLERP J: Dringliche Mundgesundheitsprobleme der Bevölkerung im vereinten Deutschland. Institut der Deutschen Zahnärzte, Köln (1991) B^UDTZ-J^ØRGENSENE, M^OJONP, R^ENTSCHA, R^OEHRICHN,^{VON DER}

MUEHLLD, BAEHNIP: Caries Prevalence and associated risk factors in recently hospitalized elderly persons. Acta Odontol Scand 54: 251–256 (1996)

C^LARKSONJ E, W^ORTHINGTONH V: Association between untreat- ed caries and age, gender and dental attendance in adults.

Community Dent Oral Epidemiol 21: 126–128 (1993) DRAKE C W, BECKJ D, LAWRENCE H P, KOCHG G: Three-year

coronal caries incidence and risk factors in North Carolina Elderly. Caries Res 31: 1–7 (1997)

D^UFOO S, M^AUPOMÉG, D^ÍEZ-^DE-B^ONILLAJ, H^ERNÁNDEZ-G^UER-

REROJ C: Caries experience in a selected patient population in Mexico City. Community Dent Oral Epidemiol 24: 298–299 (1996)

E^INWAGJ, K^ESSK, R^EICHE: Oral health in Germany: diagnostic criteria and data recording manual. Deutscher Ärzte-Verlag, Cologne (1992)

ERIKSENH M, MARQUESM D, BJERTNESSE, MOEB: Dental caries determinants in an adult Portuguese population and a com- parison with Norwegian adults. Acta Odontol Scand 54:

49–54 (1996)

FELDMANND, HEFTIA, DECROUSAZP, MARTHALERT M, HOTZP, M^ENGHINIG D,V^OCKP: Zahnkaries (DMFT) bei Erwachsenen in der Schweiz (1988). Schweiz Monatssch Zahnmed 103:

835–843 (1993)

F^URE, S., Z^ICKERT, I: Prevalence of root surface caries in 55-, 65-, and 75-year-old Swedish individuals.Community Dent Oral Epidemiol 18: 100–105 (1990)

FURES: Five-year incidence of caries, salivary and microbial con- ditions in 60-, 70- and 80-year-old Swedish individuals.

Caries Res 32: 166–174 (1998)

G^OULTSCHINJ, C^OHENH, D^ONCHINM, B^RAYERL, S^OSKOLNEW:

Association of smoking with periodontal treatment needs. J Periodontol 61:364–367 (1990)

HOLST D, SCHULLERA, GRYTTEN J: Future treatment needs in children, adults, and the elderly. Community Dent Oral Epi- demiol 25: 113–118 (1997)

H^UGOSONA, K^OCHG, B^ERGENDALT, H^ALLONSTENA L, S^LOTTEC, THORSTENSSONB, THORSTENSSONH: Oral health of individuals aged 3–80 years in Jönköping, Sweden in 1973, 1983, and 1993. Swed Dent J 19: 243–260 (1995)

K^ALSBEEKH, T^RUING J,^VANR^OSSUMG M J M,^VANR^IJKOMH M, POORTERMANJ H G, VERRIPSG H: Trends in caries prevalence in Dutch adults between 1983 and 1995. Caries Res 32: 160–

165 (1998)

M^ICHEELISW, B^AUCHJ: Oral health of representative samples of Germans examined in 1989 and 1992. Community Dent Oral Epidemiol 24: 62–67 (1996)

MÜHLEMANNH R: Patientenmotivation mit individuellem Inten- sivprogramm für orale Gesundheit. In: Peters, S (Eds): Pro- phylaxe. Ein Leitfaden für die tägliche Praxis. Quintessenz, Berlin (1978)

PAGER C, BECKJ D: Risk assessment for periodontal disease. Int Dent J 47: 61–87 (1997)

PAPASA, JOSHIA, GIUMTAJ: Prevalence and intraoral distribution of coronal and root caries in middle aged and older adults.

Caries Res 26: 459–465 (1992)

P^AYNEB J, L^OCKERD: Relationship between dental and general health behaviors in a Canadian population. J Public Health Dent 56: 198–204 (1996)

PETRIDOUE, ATHANASSOULIT, PANAGOPOULOSH, REVINTHIK: So- ciodemographic and dietary factors in relation to dental health among Greek adolescents. Community Dent Oral Epi- demiol 24: 307–311 (1996)

PISTORIUS A, WILLERSHAUSEN-ZÖNNCHEN B, ZIMMERMANN M:

Dental Status of outpatients in a university dental clinic. Acta Med Dent Helv 2: 173–177 (1997)

P^REBER H, B^ERGSTROM J: Occurrance of gingival bleeding in smoker and non-smoker patients. Acta Odontol Scand 43:

315–320 (1985)

SAKKIT K, KNUUTTILAM L, VIMPARIS S, KIVELAS L: Lifestyle, dental caries and number of teeth. Community Dent Oral Epidemiol 22: 298–302 (1994)

S^CHEUCHE: Das Interview in der Sozialforschung. In: König R (Eds): Handbuch der empirischen Sozialforschung. Band 2:

Grundlegende Methoden und Techniken. Part I. Ferdinand Enke Verlag, Stuttgart, pp 66–190 (1973)

S^IEGRIST J: Medizinische Soziologie. Urban Schwarzenberg, Munich (1988)

T^URESKYS, G^ILMOREN D, G^LICKMANI: Reduced plaque forma- tion by the chlormethyl analogue of Vitamine C. J Periodontol 41: 41–3 (1970)

WHO: Oral Health surveys, Basic methods. Third edition, World Health Organisation, Geneva (1987).